Form W-10, Dependent Care Provider’s Identification Instructions
This form contains 6 fields organized into 2 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Dependent Care Provider Identification (Part I) | ||
| Part I - Dependent care provider name | Text |
Enter the full legal name of the dependent care provider (individual or business) as it should appear for tax reporting.
|
| Part I - Provider address (number, street, and apt. no.) | Text |
Enter the provider’s street address including house or building number, street name, and apartment or suite number if applicable.
|
| Part I - City, state, and ZIP code | Text |
Enter the city, two‑letter state abbreviation, and ZIP code corresponding to the provider’s address entered above.
|
| Part I - Provider’s taxpayer identification number (TIN) | Text |
Enter the provider’s taxpayer identification number (EIN or SSN) used for tax reporting, including all digits as normally provided.
|
| Part I - If the above number is a social security number, check here | Checkbox |
Check this box when the Provider's taxpayer identification number entered above is a Social Security Number (SSN). Fill only if 'Part I - Provider’s taxpayer identification number (TIN)' is a social security number.
Depends on:
Part I - Provider’s taxpayer identification number (TIN)
|
| Person Requesting Part I Information (Name and Address, Part II) | ||
| Part II - Name and Address of Person Requesting Information | Text |
Enter the full name and complete mailing address (street address, apartment or unit number if applicable, city, state, and ZIP code) of the person requesting the Part I information.
|